Assigning staff vs.floats in ICU

[evening]

Does anyone have this issue: Our institution has many ICU's and also uses an "ICU Float Pool" as well as STAT Nurses and a Designated ICU Nurse position. These nurses help out on floor, and take an assignment in the ICU as needs arise. This is the question: When a sick admission comes in,we in the ICU feel our own staff nurses should admit the sick patient, not a Float. A couple of Charge Nurses are assigning these sick ICU patients to Floats who do NOT have the experience that we in the ICU have, do not have the experience of the specific ICU. Can anyone share experiences, thoughts? Thanks!

[meandragonbrett]

ICU Float Pool? Those should be experienced ICU RNs, no?

I always admit my younger and/or newer ICU nurses with the sick patients. That is the only way they will learn how to take care of them and it's the onyl way they will become "comfortable" caring for critically ill unstable patients.

I supervise quite a large number of ICU beds on the weekends. We don't have a float pool but we do ocassionaly have a nurse pulled from progressive care or from tele/MS. PCU RNs are given patient assignments when floated to the ICU but they do not receive IABP, PA Caths, CVVH/CRRT/SLED, anybody requiring massive transfusion, or septic shock. They generally receive two table vents that might be on a pressor or other vasoactive substance but that is stable. Medsurg/tele nurses NEVER receive an assignment but rather are there to help chart vitals, do accu checks, help turn, help travel, give IVPB (that they are able to give), help bathe, etc.

It's the job of the experienced ICU RNs to allow the younger ICU RNs to have sick and unstable patients and to be there as a mentor and a resource to help guide them. Otherwise if we take them all the time and they onyl get the stable ones.....when their "stable" vent goes south......they will spin like a top and not be able to maintain their composure.

I also don't let my newer nurses drown when I admit them a sick patient. I go and help with the admission and get them through it.

Just my

[tewdles, RN]

Sounds like bad management decisions...sick admits to the unit should be cared for by a unit nurse, not a float.

Makes me wonder what the heck some of these nursing managers are taught and are thinking...do they realize they are responsible for the care that is given by the nurses they are supervising? Do they realize that if something untoward happens they will be deposed and asked why they made the patient assignments that they made?

I am in complete agreemtent with meandragonbrett

[MERRYWIDOW46]

We have two levels of float pool at my facility. One is the Critical Care float pool, these nurses must have a minimum of two years recent critical care experience. They must pass a medication and arrythmia test, and are oriented one full week in each ICU (we have 6 ICU units).

The other is MED/SURG float pool. These nurses must have two years recent experience in med/surg, tele, PCU. These nurses must pass a medication and arrythmia test also and are orieted one full week in each specialty, medicine, surgery, PCU, neuro, ortho, and burns.

Every nurse must be BLS, arrythmia, medication, ACLS, and trauma competent. (We are also a major trauma center).

Maternal/Child health has their own floaters. PACU is just starting to use floaters with prior PACU experience following an orientation.

Everyone is professional, and capable. Some units are easier and better to work on than others. However, every nurse is assigned based on their competency. Administration is very supportive and provides necessary orientation and education.

[pghfoxfan]

I do not give "Float" nurses a difficult patient when possible. IMO, it is not in the patients best interest. For the most part, they are less comfortable with the routines, doctors, and location of supplies, meds etc. It's called common courtesy.

[wooh, BSN, RN]

I've floated from med/surg to ICU, and was generally given stable patients and wasn't supposed to get admits. When ICU nurses floated to the floor, we'd try to give them stable patients and hold back on giving them admits. It's not that I couldn't handle an ICU patient, but I'm not used to their routines. ICU nurses come out to the floor, and 6 or 7 patients is a whole different world than 2 really sick ones, and you can drown really quick if you try to care for 6 like you would 2.

It's better for EVERYONE involved if you try to be nice to the floats wherever they may be.

I'm betting people just don't want to give up a patient to get an admit. (Understandably, it just really sucks to get into a rhythm with a patient, feel like you've got them settled, and then have to start from scratch.) And that's coloring their view of the situation.

[evening]

Thanks for all the really thoughtful posts. We try and be kind to Floats, as we float to and from very specialized units and a CCU RN floating to Trauma is in a different area completely.

the Stat RNs are floating around the house to take patients to CAT scan, do IVCS on the floor, and, if a patient comes to the ICU, come to that unit. I feel if a patient is not so sick: or if the ICU RNs all have sick patients, then the Stat RN can take the patient. But, if there are a few patients waiting to go out, or are on long-term ventilators, the Stat RN should take that assignment and the RN who has dedicated years to the ICU, and knows the unit, the meds, the docs, should take the patient. Granted, there are a lot of grey areas here, and we wouldn't want to make a hard and fast rule.

It sounds to me like many of the responders feel that common sense should rule the day.

[celclt]

ICU Float Pool? Those should be experienced ICU RNs, no?

I always admit my younger and/or newer ICU nurses with the sick patients. That is the only way they will learn how to take care of them and it's the onyl way they will become "comfortable" caring for critically ill unstable patients.

Just my

I want you as a manager meandragon!!!

[herring_RN, ASN, BSN]

I think a charge nurse, research nurse, or clinical nurse specialist needs to hear report and be available for any nurse whose competency for the specific unit is not validated and a comprehensive orientation to that unit completed with a preceptor.

And only experienced critical care nurses should float to any ICU.

I have gone through registry to a hospital and been assigned post transplant patients. But they were the long term confused ventilated and infected patients. PLUS the CNS heard report, gave me a short inservice on what to look for, and was available at all times.

She even brought me a STAT antibiotic so I could stay with my two patients.

[neko11111]

I believe most hospitals require critical care floats to have at least 2 yrs experience in that field. I have been an ICU nurse my entire career, with a short stent in ED, and CCU. I just relocated to VA, and about to take on a float job to the ICU / ED / PACU at a hospital.

I would hope that your facility would only hire experienced RN's for that float pool. Otherwise, that sounds like poor management decisions..... If you and your other staff nurses feel they are not qualified, then talk to your charge nurse about it? I also know how 'us ICU nurses' can be ;0) we only feel that we can do it the right way... and can be protective of our patients.

I'm just saying, they should be experienced, qualified nurses in order to take on a float pool position.